Medical Library Access - Revisited

 

It has been 2 years since I posted about the problems with medical library access if you are not faculty or adjunct faculty at your state medical school.  In that previous post I detailed all of the considerations and you can review them in that post. Several of us lost access during some turmoil at the University and my understanding is that we were taken off the necessary status by an interim department head who was not a psychiatrist.  My basic argument is that every physician in the state needs access for quality care purposes and if the medical school was no longer willing to provide that access, I would be happy to purchase it.  I was given a quote of $1,000 per year and let everyone who needed to know that I was willing to pay it. No response from anyone.

Since that original post, I contacted my state representatives. I got the usual “I agree with you and will look into it and get back to you.” But nothing beyond that. Nobody got back to me. Despite a good response from a post to the original nothing else happened.

I joined the University of Minnesota Alumni Association because I was told that would allow some access to the online library but nobody could tell me how much access I would have to the Health Sciences Library (formerly known as the Biomedical Library). I ended up with no access to anything.  Even though I clearly met alumni criteria nobody was ever able to send me what I needed for access.

While all of this was going on – I had to get access where I could. That typically involves an initial Google Scholar search looking for links to full text access in that format. A major online resource that was linked to Google Scholar removed that access last year. The links remained for a while but it was apparent you needed a subscription to access them and it was impossible to apply without a university affiliation. If Google Scholar fails I check Medline (PubMed) to see if full text is available.  Failing that I will go to Research Gate to see if full access is available there. When that does not work I will send an email to the corresponding researcher either on Research Gate or directly to an email address listed in the original paper. I have paid the charge for paywalled research only once, but I did subscribe to the Nature journals package for $30/month. So add $360/year to my previous total for journals access. It is not unusual to find out that you don't really have access to all of the Nature journals that you need. 

Many colleagues with medical library access from across the country volunteered to send me the articles I wanted for whatever I was researching at the time. I am very grateful for those offers – but the practical issue is the amount of reading I do.  It is impractical to ask anyone to provide that level of access unless they are being paid to do it.  The other issue is legality. Every library originated paper even in the electronic format – comes with a legal statement about copyright laws and something to the effect that I am the only end user and it will not be posted in an electronic format or shared with anyone else.  

I also tried county libraries to see if I could get access to medical journals.  Two years ago I applied – and went to their online site and there was nothing.  This year I reapplied for a library card and this time it was linked to a metropolitan county library with digital access to journals. There is a lengthy request form for every article accessed and that form times out quickly and erases all of the data that you entered.  If you can get past that point and the journal is in their database  – you can get a PDF of the requested paper. The turnaround time is 2-3 days and the barriers are such that it keeps the levels of requests low. So far, in the past 6 months I have requested and received about 10 papers.  I am hoping some day that they streamline the process.

That has been the battle for access to technical information on medicine and psychiatry. The county library access was a pleasant upside. The University’s Heath Science Library still looms large. I think the notion of a large taxpayer funded library for health sciences students and trainees that is only available to them when they are students, trainees, or faculty is an antiquated idea. Physicians are trained in lifelong learning.  To accomplish that goal – lifelong access to information is needed. Access is currently given to adjunct uncompensated faculty as a perk and that may be the real reason for not allowing a physician to pay for access. In other words it is a business management strategy. If access is controlled - the service becomes more valuable and it seems like uncompensated adjunct faculty are really getting something for their time.  I doubt that there would be a tremendous increase in utilizing the services even if they were free. It would be much more efficient because it would not require library staff somewhere – to read and decipher all of the requests when the physician could just find the journal and get exactly what they need. If you are reading this from a state other than Minnesota – I am very interested in hearing how you access the medical literature online if you are not medical school staff and do not have a subscription to the journal you want to access.

In the meanwhile – I will keep plugging away at my work arounds.

George Dawson, MD, DFAPA